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  • Writer's pictureDavid Engelman

What to Expect at a Hearing Aid Fitting

Updated: Jan 22

Woman being fitted with a hearing aid.

The hearing aid fitting appointment is a critical component of your success with hearing aids. The purpose of this appointment is to ensure your hearing aids are set properly for your specific hearing prescription, while considering your personal hearing needs and goals. The appointment will also have a strong educational component to it, where you will learn all about your hearing aids—how to use them, take care of them, and how to put them in your ears. Let’s dive a bit deeper into what will happen during this appointment.

The Hearing Aid Prescription

The hearing aid prescription is largely based on the results of your hearing assessment, shown in graphic form in an "audiogram".
The hearing aid prescription is largely based on the results of your hearing assessment, shown in graphic form in an "audiogram".

Hearing aids are set to a prescription based on the specific severity and type of hearing loss that you have. The level of sound prescribed will vary based on how much loss of hearing you have, and which frequencies of sound are affected by that hearing loss. There also may be variations in the prescription depending on if your hearing loss stems from the inner ear or middle ear (or perhaps, a combination of both). In other words, your hearing aids will be uniquely prescribed for your hearing. Therefore, you wouldn’t be able to “swap” hearing aids between other people, to see if maybe you like the sound of someone else’s hearing aids better, as the prescription will not be appropriate for your hearing.

Just about all hearing aids nowadays are digital and are very high-tech instruments. The prescription is created via special software on the audiologist’s computer, which then programs the prescription into the hearing aid. A single hearing aid can usually be programmed with a wide range of prescriptions and amplification levels, but some models will be more suitable for certain degrees of hearing loss than others.

Measuring Hearing Aid Performance

We need to make sure that once the hearing aids are in the ears, they are performing properly to meet the prescription. We refer to this as the hearing aid “target”, as it represents the level of sound that we want the hearing aids to be providing to the patient. This is done through what’s referred to as a “real-ear measurement” or REM for short. This is because the measurement reflects what is really happening inside the patient’s ear—in contrast to a laboratory setting where the hearing aids will originally be tested by the manufacturer, or even by the audiologist themselves with specialised equipment.

The procedure for the REM is easy, as unlike the hearing test, you don’t have to do anything or pay attention to anything! It will involve painlessly placing a small, soft tube gently inside the ear, that measures the levels of sound entering the ear canal, going to the eardrum. All you will need to do is face a speaker, where sounds will be played from. In the UK, the International Speech Test Signal is commonly used. This is a jumble of various languages mixed together that represents different properties of speech typically used across all languages. During this measurement, the audiologist can determine if the correct levels of sound are entering the ear canal and can make adjustments to the prescription if it isn’t.

I would note that not all audiologists perform the REM procedure, and while I’m sure many do have valid reasons for not doing so, I personally feel it is important. It helps achieve a good baseline for where the hearing aid needs to be set to, and then further adjustments can be made to optimise the settings specifically according to the patient’s needs.

Checking and Customising the Sound

Screenshot of one of the screens an audiologist can use in their software to improve the benefit you get from your hearing aids.
Screenshot of one of the screens an audiologist can use in their software to improve the benefit you get from your hearing aids.

After completion of the REM, the audiologist will check to see how everything is sounding while talking to you. It can be useful to bring someone else to this appointment with whom you regularly communicate, as it is helpful to hear a voice that you are familiar with. Usually, most people will at first find hearing aids to be either too loud, echoey, or tinny—often a combination of all these! This is very normal and means the hearing aids are doing their job, but it does take some time to get used to. If you are finding any of those sensations to be overly uncomfortable, then your audiologist can reduce some of the amplification and allow you to “ease” into the settings a bit. Alternatively, especially if you are already an experienced hearing aid user, you may prefer the hearing aids to be louder!

Your audiologist may also set up various programs for you to use on your hearing aids, which can be accessed either through a button on the hearing aid, or via a mobile phone app paired to the hearing aids. Some examples might include a program that optimises sound quality for music, or a program to connect to public hearing loop systems. If you’ve never worn hearing aids before though, I usually think it’s best not to set up any programs during the fitting appointment. For many people, they won’t be necessary, as the hearing aids running at their default, automatic settings will provide more than enough benefit. It can be worth waiting until one of your follow-up appointments to determine if programs may make sense for you. Some hearing aids also may not have the option for any programs at all—this will usually be the case in the smallest models which can be a bit more limited in their technological capabilities.

Learning How to Use the Hearing Aids

Man having a hearing aid fitted.

Once both you and your audiologist are satisfied with the initial settings of the hearing aids, you will then be shown everything you need to know about using them. This will be a lot of information to process, but you will receive an instruction booklet as well. You can also review anything you’re unsure of at a follow-up appointment. The main things that your audiologist will cover will be 1) how to tell the difference between the right and left hearing aid (yes, they are different!), 2) how to change or charge the batteries, 3) how to clean and maintain the hearing aids, 4) how to put the hearing aids in your ears, and lastly, 5) review other important considerations to be aware of (i.e. do’s and don’ts, expectations, and strategies to maximise benefit)

Some Final Thoughts

I would end by saying that there can be some variation in how this appointment is structured, and that will of course depend on the audiologist that you see, as well as your own needs, questions, and concerns. It is important though that you leave your hearing aid fitting feeling confident in your abilities to use and wear the hearing aids. It is normal to sometimes feel a bit overwhelmed by it all, but with some patience and perseverance, hearing aids will just become a normal part of your daily routine.

If you'd like to learn more about the kind of hearing care we provide for our patients at Finchley Hearing, please explore our website and feel free to get in touch with any questions.

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